By Bethany Blankley and Dan McCaleb | The Center Square
Former Louisiana state Sen. Conrad Appel says the state’s oldest residents should have a choice, including those with lower incomes. Rather than being forced into nursing homes when they need help with care, they should be able to receive services in the comfort of their homes.
Two years ago, Appel attempted to pass legislation that would have allowed many senior citizens on Medicaid to receive home-based care rather than be forced into nursing homes.
The powerful nursing home lobby in the state helped squash Appel’s efforts, he said.
As COVID-19 wreaks havoc on nursing homes, where more than 45 percent of all Louisiana coronavirus deaths have been reported, Appel, of Metairie, hopes state officials will reconsider their decision, though he doesn’t think it will happen under Gov. John Bel Edwards.
“In Louisiana, the two largest contributors to the political process are, No. 1, the trial lawyers, and No. 2, the nursing homes,” Appel said. “The governor is beholden to the nursing homes. And they [nursing home lobby] also contribute to legislators. They’ve taken advantage of that political stroke and they have gotten laws passed that have helped their financial situation.”
Senate Bill 357 sought to move Medicaid recipients in the state under a managed care model, which would have allowed the state to use federal tax dollars under the Medicaid program to pay for in-home services. Home care, while preferred by 90 percent of seniors surveyed by AARP, also is significantly less expensive than nursing home care.
“If people are able to and are willing to, then those funds should be made available for services in the home,” Appel said. In addition to the quality of life improvements, the legislation “would save about $100 million a year” for the state because of lower costs.
As of Monday, state health officials reported 3,004 COVID-19 related deaths in Louisiana. About 1,400 of those coronavirus deaths were residents of nursing homes and other adult residential facilities. The percentages are similar in states across the country.
The Louisiana Department of Health said earlier this month that it plans to study COVID-19 in nursing homes to better handle the spread of infectious diseases in the future.
The Department of Health, the office of Gov. John Bel Edwards, and the Louisiana Nursing Home Association did not respond to requests for comment.
John Kay, vice president for advocacy at the Pelican Institute for Public Policy, told The Center Square that aging Louisianans are safer at home during the COVID-19 pandemic.
“In recent years, Louisiana Medicaid spending has ballooned, with little to no accountability and mountains of evidence of fraud and abuse,” Kay said. “All the while, Louisiana’s elderly Medicaid population continues to wait for the flexibility to choose in-home care instead of being forced into a nursing home.”
More seniors should have options, Kay said.
“Entrenched special interests have blocked these reforms for too long, and now is the time for Governor Edwards to make good on his 2015 campaign promise and provide much-needed flexibility to Medicaid patients currently faced with entering a nursing home,” Kay said.
About 12,000 seniors are on home health care waiting lists, Andrew Muhl, associate state director of Advocacy for AARP Louisiana, said. Muhl also supports giving seniors a choice.
“If you want a choice on where to live, we feel you should have that choice,” Muhl said. “Louisiana is choosing the most expensive form of long-term care,” meaning fewer people receive the care they need because of limited dollars.
Muhl also said Louisiana doesn’t need legislation to use Medicaid dollars to pay for care for seniors at home.
“The governor can do it on his own. He doesn’t need a law passed,” he said. “He can do it by authorizing the Department of Health to do it.”
With that end in mind, supporters of giving seniors that choice hope the pandemic will change minds.
“The message we’ve been trying to give the governor is we rank near the bottom in health outcomes for seniors. We have to do anything we can to improve that,” Muhl said. “I think that if the pandemic has taught us anything, it’s that there are safer ways to take care of our loved ones than congregate settings. Our hope is that the governor recognizes this and acts accordingly.